By MICHELLE R. SMITH, SCOTT BAUER and MIKE CATALINI

PROVIDENCE, R.I. (AP) — The flashy postcard, covered with images of syringes, beckoned people to attend Vax-Con ’21 to learn “the uncensored truth” about COVID-19 vaccines.

Participants traveled from around the country to a Wisconsin Dells resort for a sold-out convention that was, in fact, a sea of misinformation and conspiracy theories about vaccines and the pandemic. The featured speaker was the anti-vaccine activist who appeared in the 2020 movie “Plandemic,” which pushed false COVID-19 stories into the mainstream. One session after another discussed bogus claims about the health dangers of mask wearing and vaccines.

The convention was organized by a profession that has become a major purveyor of vaccine misinformation during the pandemic: chiropractors.

At a time when the surgeon general says misinformation has become an urgent threat to public health, an investigation by The Associated Press found a vocal and influential group of chiropractors has been capitalizing on the pandemic by sowing fear and mistrust of vaccines.

They have touted their supplements as alternatives to vaccines, written doctor’s notes to allow patients to get out of mask and immunization mandates, donated large sums of money to anti-vaccine organizations and sold anti-vaccine ads on Facebook and Instagram, the AP discovered. One chiropractor gave thousands of dollars to a Super PAC that hosted an anti-vaccine, pro-Donald Trump rally near the U.S. Capitol on Jan. 6.

They have also been the leading force behind anti-vaccine events like the one in Wisconsin, where hundreds of chiropractors from across the U.S. shelled out $299 or more to attend. The AP found chiropractors were allowed to earn continuing education credits to maintain their licenses in at least 10 states.

Public health advocates are alarmed by the number of chiropractors who have hitched themselves to the anti-vaccine movement and used their public prominence and sheen of medical expertise to undermine the nation’s response to a COVID-19 pandemic that has killed more than 700,000 Americans.

“People trust them. They trust their authority, but they also feel like they’re a nice alternative to traditional medicine,” said Erica DeWald of Vaccinate Your Family, who tracks figures in the anti-vaccine movement. “Mainstream medicine will refer people out to a chiropractor not knowing that they could be exposed to misinformation. You go because your back hurts, and then suddenly you don’t want to vaccinate your kids.”

The purveyors of vaccine misinformation represent a small but vocal minority of the nation’s 70,000 chiropractors, many of whom advocate for vaccines. In some places, chiropractors have helped organize vaccine clinics or been authorized to give COVID-19 shots.

And chiropractic is not the only health care profession whose members have been associated with COVID-19 misinformation: Some medical doctors have spread dangerous falsehoods about vaccines, a problem so concerning that the national group representing state medical boards warned in July that doctors who push vaccine disinformation could have their licenses revoked.

But the pandemic gave a new platform to a faction of chiropractors who had been stirring up anti-vaccine misinformation long before COVID-19 arrived, driven by interpretations of 19th century chiropractic beliefs that medicine interferes with the body’s natural flow of energy.

Chiropractic was founded in 1895 by D.D. Palmer, a “magnetic healer” who argued that most disease was a result of misaligned vertebrae. Its early leaders rejected the use of surgery and drugs, as well as the idea that germs cause disease. Instead, they believed the body has an innate intelligence, and the power to heal itself if it is functioning properly, and that chiropractic care can help it do that.

This led many to reject vaccines — even though vaccines are not within their scope of practice. Instead, they treat conditions through spine and musculoskeletal adjustments, as well as exercise and nutritional counseling. A 2015 Gallup survey found an estimated 33.5 million adults had seen a chiropractor in the previous 12 months.

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Even before the pandemic, many chiropractors became active in the so-called “health freedom” movement, advocating in state legislatures from Massachusetts to South Dakota to allow more people to skip vaccinations.

Since 2019, the AP found, chiropractors and chiropractor-backed groups have worked to influence vaccine-related legislation and policy in at least 24 states. For example, an organization started by a chiropractor and a co-owner of a chiropractic business takes credit for torpedoing a New Jersey bill in early 2020 that would have ended the state’s religious exemption for vaccines.

Then the pandemic hit, creating new avenues for profit.

The first complaint the Federal Trade Commission filed under the COVID-19 Consumer Protection Act was in April against a Missouri chiropractor. It alleges he falsely advertised that “vaccines do not stop the spread of the virus,” but that supplements he sold for $24 per bottle plus $9.95 shipping did. He says he did not advertise his supplements that way and is fighting the allegations in court.

Nebraska chiropractor Ben Tapper landed on the “Disinformation Dozen,” a list compiled by the Center for Countering Digital Hate, which says he is among the small group of people responsible for nearly two-thirds of anti-vaccine content online. Tapper went viral with posts downplaying the dangers of COVID-19, criticizing “Big Pharma,” and stoking fears of the vaccine.

Tapper said he has been called a “quack” and lost patients, and that Venmo and PayPal seized his accounts. In his view, the public is being told that they need a vaccine to be healthy, which he doesn’t believe is true. He said vaccines have no place in what he calls the “wellness and prevention paradigm.”

“We’re trying to defend our rights,” Tapper told AP, when asked why so many chiropractors are involved in the anti-vaccine movement. “We’re defending our scope of practice.”

Another chiropractor, who has frequently appeared on the right-wing show operated by conspiracy theorist Alex Jones to sell supplements, was also a donor to an organization that was behind the anti-vaccine demonstration on Jan. 6.

It’s unclear how widespread anti-vaccine sentiment is in the ranks of chiropractors, but there are some clues.

Stephen Perle, a professor at the University of Bridgeport School of Chiropractic, recently surveyed thousands of chiropractors across the United States. He said his and other surveys show that less than 20% of chiropractors have “unorthodox” views, such as opposition to vaccines. Perle called that group an “exceedingly vocal, engaged minority.”

AP could find no national numbers of vaccination rates among chiropractors, but Oregon tracks vaccine uptake among all licensed health providers, and the numbers show chiropractors and their assistants are by far the least likely to be vaccinated — and far less than the general public.

Just 58% of licensed chiropractors and 55% of chiropractic assistants in Oregon were vaccinated as of Sept. 5. That’s compared to 96% of dentists, 92% of MDs, 83% of registered nurses, 68% of naturopathic physicians, and 75% of the general public.

Vaccines save millions of lives around the world by preventing diseases such as measles and flu, and they have shown to be overwhelmingly effective in reducing hospitalization and death in coronavirus patients. More than 400 million doses of COVID-19 vaccines have been administered in the U.S. alone — and hundreds of millions more worldwide — and serious side effects are exceedingly rare.

But dozens of chiropractors spread doubt on their own websites about vaccines, including those for COVID-19. One chiropractor in North Carolina says people who get flu shots are “poisoning themselves.”

A patient testimonial on the website of a chiropractor in Georgia proclaims, “Dr. Lou has taught me how toxic shots and vaccinations are.” Another, for a chiropractor in Pennsylvania, says that in less than two months of treatments, “the vaccination against contracting diphtheria (that was given to me as a child over 50 years ago) had been expelled from my body!” A chiropractor in Hollywood warns of the “dangers and unfortunately the EVIL associated with the new covid-19 vaccine.”

A Michigan chiropractor, Kyle McKamey, tells patients on a pediatric intake form “If you would like information regarding the dangers of vaccines and how to refuse them, let us know!” The line is punctuated by a smiley face emoji.

McKamey offered to write notes exempting people from vaccine and mask mandates, and said even if they weren’t a patient, they could become one and get a note, according to a Facebook post spotted by the ABC affiliate in South Bend, Indiana. He wrote in the post that “as a licensed Doctor of Chiropractic, I have the same authority” as a medical doctor to write exemption notes. McCamey did not return messages seeking comment.

The AP also found some chiropractors were selling anti-vaccine ads on Facebook and Instagram, including one in California who pushed a link to a disinformation-filled video series about vaccines that AP previously reported has paid out millions to affiliates who helped sell the product.

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The pandemic has also led to huge fundraising opportunities for chiropractors and anti-vaccine groups.

On the West Coast, a chiropractic seminar and expo called Cal Jam, run by chiropractor Billy DeMoss, said in 2019 it raised a half-million dollars for a group led by one of the world’s most prominent anti-vaccine activists, Robert F. Kennedy Jr. Photographs posted online show DeMoss and others presenting Kennedy with a giant check for $500,000. The check’s signature line read “Chiropractic Rebels.”

The amount represents a huge portion of Children’s Health Defense’s 2019 revenues, about one-sixth of the nearly $3 million it raised that year, according to the group’s tax forms. In the weeks and months that followed the chiropractors’ fundraiser, Kennedy traveled around the U.S., including to Connecticut, California and New York, to lobby or sue over vaccine policies.

This summer, DeMoss and Children’s Health Defense raised another $45,000, DeMoss said in an Instagram post, adding that he and Kennedy “have graced many stages together and raised hundreds of thousands of dollars” for Kennedy’s organization.

Children’s Health Defense is a ubiquitous source of false and misleading information about vaccines, and Kennedy has been banned on Instagram and was also labeled a member of the “Disinformation Dozen.”

DeMoss and Cal Jam did not respond to emails seeking more information about the donations. Laura Bono of Children’s Health Defense said the group does not make donor information public.

Another group, Stand for Health Freedom, was co-founded in 2019 by another member of the “Disinformation Dozen,” Sayer Ji, along with chiropractor, Joel Bohemier, and Leah Wilson, who co-owns a chiropractic business in Indiana with her chiropractor husband.

Stand for Health Freedom says it has an estimated reach of 1 million “advocates,” and it takes credit for killing the 2020 New Jersey bill on religious exemption for vaccines.

The group’s website says that in just one week, more than 80,000 emails were sent to New Jersey lawmakers through its portal. In a video presentation earlier this year at the Health Freedom Summit, an online conference populated with anti-vaccine figures, Wilson said another round of advocacy resulted in 30,000 more emails to lawmakers.

“We heard numerous times from these elected officials that they’ve never had such an outpouring of communication coming into their inboxes and coming through their phone lines as they did with this specific issue,” Wilson said.

The group, which has not filed as a lobbying organization in any state, is currently pushing people to send messages opposing vaccine mandates to lawmakers in states including Iowa and South Dakota, and says it has gathered more than 126,000 signatures on a petition to oppose vaccine mandates for air travel. Wilson said during an appearance at an anti-vaccine event on Sept. 19 in Indianapolis that over the past month, “120,000 new advocates had taken action through Stand for Health Freedom.”

The group reported nearly $200,000 in revenue in 2020, an amount Bohemier said in an email came from “advocate donations.”

New Jersey Senate Democratic President Steve Sweeney told AP that he was concerned some chiropractors were running afoul of the state’s truth-in-advertising law because they’re spreading anti-vaccine misinformation.

“Chiropractors are violating the law and giving medical advice, and the ones that are found to violate the law should have their licenses stripped from them,” he said. “They’re not medical doctors, and they’re giving advice as if they’re experts and they’re not.”

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In Wisconsin, Vax-Con was not just a way to spread anti-vaccine conspiracy theories. It was a way to make money.

Tickets cost $299 for chiropractors who were members of the event’s organizer, The Chiropractic Society of Wisconsin, and $129 for chiropractic technicians. Nonmember chiropractors paid $399.

Georgia-based Life University, which bills itself as the world’s largest single-campus chiropractic university, acted as Vax-Con’s sponsor and vouched for the program as “viable postgraduate materials” in a letter to state regulators. For its role, the school was paid $35 per attendee, according to its president, Robert Scott.

Brian Wussow, a chiropractor and vice president of the Chiropractic Society of Wisconsin, later told a state Senate committee that more than 400 chiropractors and 100 chiropractic technicians from Minnesota, South Dakota, Illinois, Iowa and Kansas attended.

“In fact, the demand for this CE program was so great the numbers do not reflect the actual interest to attend, but the capacity of the room at the hotel,” he said, according to written testimony.

Based on ticket prices, the event would have generated revenue of at least $130,000.

Offering continuing education courses is so lucrative that the Chiropractic Society of Wisconsin has been pushing the Legislature to allow it to sponsor such courses directly, without going through a provider such as Life University.

Wussow contended Vax-Con’s program was not against vaccines.

But that was not supported by a review of some of the course materials found by the AP on the Chiropractic Society of Wisconsin website. The featured speaker, “Plandemic’s” Judy Mikovits, for example, included a number of false and unsupported claims in her 34-page presentation, including that vaccines drive pandemics and that vaccines and masks contribute to the development of chronic disease.

Life University President Scott told AP that 10 states have accepted the Vax-Con program for continuing education credit.

Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, was appalled that chiropractors were earning continuing education credit to attend Vax-Con.

“When you are a licensed professional and you are spreading misinformation, should you maintain your license?” Castrucci said. “When chiropractors and physicians and medical professionals and elected leaders and social media start spreading disinformation, where are people to go for information? Where are people to go for facts?”

James Damrow, a third-generation chiropractor in Janesville, Wisconsin, has been practicing for 29 years and served as a member of the Wisconsin Chiropractic Examining Board for three. When Vax-Con sought approval to have its session count as continuing education credit, Damrow allowed it.

“I wasn’t happy with the name of the course, but when I looked into the materials, it was fairly well-referenced, peer-reviewed science, so I felt like it was good information that was something that would be OK for the doctor to know,” Damrow said. “My preference would have been to call it something different, a little less controversial.”

Damrow said he did not investigate the background of the speakers.

He said chiropractors were being unfairly cast as anti-science and “that’s not accurate.”

As recently as October 2020, the International Chiropractors Association carried what it called a “formal policy statement” on its website, saying the group “questions the wisdom of mass vaccination programs” and opposes compulsory vaccine programs which infringe upon “freedom of choice.”

The statement has since been removed but could be found in the Internet Archive.

Beth Clay, executive director of the International Chiropractors Association, said in an email that the group “takes no official position” on vaccines, but when asked whether its formal policy statement had been rescinded, she replied that it “technically” remained official. The group’s policy statements were scheduled to be reviewed in the next 18 months, she said.

Clay has been an anti-vaccine activist for decades, DeWald said. In articles for the website of Kennedy’s group in 2019, she downplayed the danger of measles and pushed a link between vaccines and autism, a claim that is unsupported by science and has been widely debunked.

Meanwhile, the American Chiropractic Association, a larger and more mainstream chiropractic group, adopted a new position statement on vaccines in June that does not take a position for or against them.

The aftershocks of Vax-Con continue in Wisconsin. One of the highest-ranking Democrats in the state pulled support for a bill that would have benefited Vax-Con’s organizers by allowing them to sponsor events that count as continuing education credits. More mainstream chiropractors are worried about what impact the meeting and its anti-vaccine message will have on the profession.

John Murray, executive director of the Wisconsin Chiropractic Association, which had nothing to do with Vax-Con, said he couldn’t understand why the state examining board approved continuing education credits for the event, given that vaccinations aren’t in the scope of practice for chiropractors.

“The way the program was marketed and the lineup of pretty much publicly avowed anti-vaxxers, any pretense of an objective treatment of the topic I think is laughable,” Murray said.

For Murray, whose group took a neutral position on recommending vaccinations, there is a clear danger when chiropractors stray from their service offering spinal adjustments.

Vax-Con, he said, was an example of a small group of chiropractors who are pushing the envelope, and diminishing the credibility of the profession.

The Chiropractic Society of Wisconsin has recently held a series of “Health Freedom Revivals” around the state, with featured speakers including Tapper and DeMoss.

One recent Sunday alongside a lake in a public park, participants paid $20 per ticket to hear speakers talk about “health freedom” and the risks of vaccines. The agenda also included some other decidedly chiropractic touches, including participants joining in group stretching exercises.

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Bauer reported from Madison, Wisconsin. Catalini reported from Trenton, New Jersey. Associated Press writers Casey Smith and Lauran Neergard contributed to this report.